Clinical Features

  • Starts classically with diffuse abdominal pain felt most prominently in the periumbilical area.
  • There is anorexia and nausea.
  • Vomiting may follow.
  • Pain then settles in the right lower quadrant and is localized at McBurney’s point.
  • The pain may be relieved briefly after perforation but is accentuated by the ensuing diffuse peritonitis.
  • There is localized tenderness in the right lower quadrant,
  • Rebound tenderness
  • Muscle guarding
  • Cutaneous hyperaesthesia
  • Pelvic tenderness in the right iliac fossa on rectal examination.
  • Rovsing’s sign may be positive and the temperature may be elevated.


Laboratory examinations are not critical for diagnosis. There is leucocytosis with neutrophilia. Normal values do not rule out appendicitis, however.


  • Initiate appropriate resuscitation.
  • Once diagnosis is made, give analgesics whilst preparing for surgery.
  • Starve the patient before surgery
  • Give premedication when there is time (atropine 0.6mg IM stat and morphine 10mg IM stat).
  • Appendectomy is the treatment of choice, once a definitive diagnosis is made.